What Are the Different Types of Head and Neck Cancer?

Approximately 645,000 new cases of head and neck cancer occur worldwide each year. In most countries, head and neck tumors are more common in men than women, and are more common in patients aged 50 years. The number of new cases in Europe in 2002 was approximately 100,800, with more than 40,000 deaths. Head and neck tumors are closely related to smoking and alcohol abuse, and the incidence is high in countries with high consumption of tobacco and alcohol.

Head and neck cancer

Head and neck tumors include tumors from any tissue or organ of the head and neck except the eyes, brain, ears, thyroid, and esophagus. They should include neck tumors, otolaryngology tumors, and oral and maxillofacial tumors. Neck tumors are general surgery in general hospitals. The most common are thyroid tumors. Otolaryngology tumors include laryngeal cancer and paranasal sinus cancer. Oral and maxillofacial tumors are various oral cancers such as tongue cancer, Gum cancer, cheek cancer, etc. Therefore, the tumors that occur in the head and neck have the largest number of primary sites and pathological types, ranking first in systemic tumors. More than 90% of head and neck tumors are squamous cell carcinoma. The incidence of head and neck squamous cell carcinoma (SCCHN) worldwide has increased significantly in the last 10 years, especially among women.

Overview of Head and Neck Cancer

Head and neck cancer hazards

Approximately 645,000 new cases of head and neck cancer occur worldwide each year. In most countries, head and neck tumors are more common in men than women, and are more common in patients aged 50 years. The number of new cases in Europe in 2002 was approximately 100,800, with more than 40,000 deaths. Head and neck tumors are closely related to smoking and alcohol abuse, and the incidence is high in countries with high consumption of tobacco and alcohol.

At the same time, the important organs of the head and neck are concentrated, the anatomical relationship is complicated, and the treatment methods are different. It also covers the medical fields of head and neck tumor surgery, oncology, radiation therapy, nutrition and speech therapy, social work, nursing and rehabilitation. However, multi-disciplinary and coordinated comprehensive treatment is required for tumors in some areas to effectively improve the treatment effect.

Head and Neck Cancer Prevention

The main causes of head and neck cancer are tobacco and alcohol, and government agencies are working hard to implement a smoking ban, especially for young people on secondary school campuses. New research shows that smoking bans can be very helpful for patients with head and neck cancer. Early surgery can reduce the risk of exacerbation or the development of a second primary tumor. Vitamin A can control the mucosal lesions before the tumor and prevent the occurrence of a second primary tumor. The application of 13-cis retinoid acid can also reduce the occurrence of secondary tumors. Currently, these studies are based on original records.

Mucosal leukoplakia is the most common precancerous lesion of the head and neck. Research on retinol to reverse mucosal leukoplakia has been carried out, with an effective rate of 55% ~ 100%. Unfortunately, 13-cis-retinoic acid has no long-lasting effect on reducing leukoplakia of the mucosa. Most of the lesions developed after 3 months of discontinuation and also had side effects. Low-dose 13-cis-retinoic acid was better than -carotene, however, low-dose 13-cis-retinoic acid and -carotene were well tolerated by both in the series investigated.

Clinical symptoms of head and neck cancer

(SCCHN) Common Symptoms of Squamous Cell Carcinoma of the Neck (SCCHN)

1. Oral ulcers do not heal for more than 2 weeks

2. Swelling of lips, mouth, or throat

3. difficulty chewing or swallowing pain

4. Persistent nasal congestion or nosebleeds

5. Swelling of the neck or jaw

6. Continuous hissing or sound changes

7. Earache

8. Restricted tongue extension

9. Pain in the face or maxilla

10. Abnormal white (leucoplakia) or red plaque on the oral mucosa

Head and neck cancer

Bottom of the mouth is most commonly the anterior floor of the mouth on both sides of the left tongue. Local ulcers or lumps may appear. Because the area of the floor of the mouth is not large, it is easy to invade the tongue band to the contralateral side; and it quickly invades the gums and the lingual bone plate of the mandible; after further invading the cancellous bone, the lower anterior teeth can loosen, Fall off. Invasion backwards, in addition to the bottom of the posterior mouth, can also penetrate the tongue and abdomen muscle layer. Late invasion of the floor muscles. Violation of the tongue can lead to dyskinesia, which is fixed in the mouth. At this time, the patient mostly had spontaneous pain and salivation was obvious. Sometimes the floor of the mouth cancer can start from one side of the back of the mouth. This type of bottom of the mouth cancer is more likely to invade the tongue and mandible early.

The cancer of the bottom of the mouth can come from white spots or lichen planus malignancy. At this time, there may be white lesions around the cancer.

Floor-of-mouth cancer, especially anterior floor-of-mouth cancer, is prone to bilateral cervical lymph node metastasis. The most susceptible ones are sub-condylar and submandibular lymph nodes, and more metastases to deep cervical lymph nodes in later stages.

Head and neck cancer

The age of onset of squamous cell carcinoma of the hard palate is similar to that of gingival cancer, but later than that of tongue and cheek cancer; the median age is after 50 years. More men with hard palate cancer (whether squamous or salivary gland cancer) than women.

Scab cancer usually starts from one side and spreads quickly to the gingival and contralateral sides. It is mostly exogenous, with marginal valgus and bleeding easily when touched; sometimes it is also ulcerated. Tobacco stomatitis or leukoplakia are sometimes seen in the mucosa around the cancer. Because the patellar mucoperiostum is in close contact with the patella, it is easy to invade bone early.

In advanced stage of cancer, the soft palate can affect the soft palate, the palatal gingiva, the alveolar process, and even the buccal gingival infiltration of the alveolar process. Compared with gingival cancer, tooth loosening and even loss may occur, but it occurs more often than early.

After the sacroiliac cancer invades the sacrum, the nasal cavity can be penetrated in the late stage, and a mass appears at the bottom of the nasal cavity; or the bottom of the maxilla is penetrated into the maxillary sinus, which becomes a secondary maxillary sinus cancer, and the symptoms of maxillary sinus cancer appear.

The lymph node metastasis of sacral carcinoma mainly invades the submandibular lymph nodes and the deep cervical lymph nodes; retropharyngeal lymph node metastasis is difficult to judge clinically, and it is mostly found during surgery. It is worth noting that bilateral cervical lymph node metastasis occurs in advanced sacral carcinoma. In our case of bilateral radical neck dissection, the first place in the palate was the first (48%). There may be more chances for cancer to cross the midline than elsewhere.

Head and neck cancer gum cancer

Gingival cancer can be clinically manifested as ulcerative or exogenous, of which ulcerative is more common. Most of the origins came from the interdental papilla and gingival margin area. The ulcers are superficial, reddish, and hyperplasia may occur in the future. Because the mucoperiosteal and alveolar process are very tight, it is easier to invade the alveolar process and bone quality at an early stage, resulting in tooth loosening and detachment.

Gingival cancer can spread from the cheek (lip) or palate (lingual) side to the opposite side through the teeth; outward to the cheek and sulcus, and inward to the bottom of the mouth and palate; invade the maxillary sinus Bottom, perforate the bone, enter the maxillary sinus, and become secondary maxillary sinus cancer; it can spread to the mandible downward, and even pathological fracture occurs in the late stage. After gingival cancer invades bone, X-ray film can appear malignant tumor destruction features-worm-like irregular absorption.

Gingival cancer often involves submandibular lymph node metastasis, and in the later stage, the lymph nodes in the upper deep cervical group are involved. Gingival cancer, if it is located in the anterior area (especially in the lower anterior area), can cause metatarsal or bilateral cervical lymph node metastases.

Head and neck cancer tongue cancer

Tongue cancer can be manifested in three types at the early stage: ulcer, exogenous and invasion. In some cases, the first symptom is only tongue pain, which can sometimes reflect to the temporal or ear. The exotype can come from malignant changes of the papilloma. The infiltrating surface can be free of protrusions or ulcers, and is most likely to delay the disease.

Tongue cancer

The advanced stage of tongue cancer can directly surpass the midline or invade the floor of the mouth, and infiltrate the periosteal membrane, bone plate or bone of the mandibular tongue. Backward can extend to the base of the tongue or anterior pharynx and the lateral wall of the pharynx. At this time, tongue movement can be severely restricted and fixed, salivary fluid overflows and cannot be controlled, and it is difficult to eat, swallow and speak. The pain is severe and can be reflected to the head on the sides.

The lymph node metastasis rate of tongue cancer is very high. The literature reports can reach 60% ~ 80%, and our department's statistics are about 40%. The sites of metastasis were the deepest cervical lymph nodes, followed by submandibular lymph nodes, deep cervical lymph nodes, subcondylar lymph nodes, and deep cervical lymph nodes. The transfer rate and number gradually increased with the T classification. T4 and advanced cases of recurrence can be transferred to the posterior cervical lymph node group (ie, the lymph nodes of the horizontal and secondary chains). Violate

Bilateral lymph node metastasis can occur in the midline, beyond the midline, or in tongue cancer that originates from the back of the tongue and the tip of the tongue.

To the advanced stage of tongue cancer, lung metastases or distant metastases from other sites can occur.

Head and neck cancer buccal mucosa cancer

Cheek cancer generally has no obvious pain in the early stage. When the cancer invades deep tissues such as infiltrating muscles or is complicated by infection, obvious pain occurs, with varying degrees of opening restriction, until the teeth close tightly. After periodontal tissue involvement, toothache or tooth loosening may occur. Patients often have submandibular lymphadenopathy and may also involve deep cervical lymph nodes. Lymph node enlargement may be caused by cancer metastasis or infection, so attention should be paid to identification.

Head and neck cancer

Lip cancer mostly occurs on one side of the lip, and it is particularly common in the middle and third parts. The average disease duration can reach more than 2 years. Lesions can manifest as proliferative, verrucous and other exogenous types, as well as ulcerative types. As the disease progresses, it can be accompanied by proliferation and ulcers, and the marginal valgus is uneven. Hemorrhage, inflammatory exudation and even secondary infection often appear on the surface of the lesion. Late cases can invade the entire lip and spread to the cheeks, muscle layer, vestibular sulcus, and even the jaw bone. Because lower lip cancer affects the closing function of the lips, patients may be accompanied by severe salivary overflow.

Lip cancer

Many cases are accompanied by precancerous lesions such as white spots around the cancer. Depending on the direction of lymph flow, metastasis to the upper iliac, submandibular, and deep neck can occur; patients with upper lip cancer should pay special attention to check the parotid lymph nodes

Diagnosis of head and neck cancer

Clinicians usually diagnose by:

Physical examination

Fiber laryngoscopy

CT or MRI or PET scan

Histological biopsy to determine pathological type

Evaluation of tumor metastasis: chest X-ray, abdominal scan, bone scan, etc.

Treatment of head and neck cancer

Head and neck tumors are clinically staged based on the size and location of the primary tumor (T), the number and size of cervical lymph node (N) metastases, and the presence of distant metastases (M). Select appropriate treatment options based on the stage of the disease (Surgery, radiotherapy, chemotherapy). For patients who have not spread locally, surgery should be performed first, followed by radiation therapy. Patients with locally advanced inoperable disease should receive 7 weeks of radiotherapy. Recent studies have shown that concurrent chemoradiotherapy can improve patient survival, but not all patients can tolerate this treatment.

Relapsed and / or metastatic patients receive palliative chemotherapy. Approximately 75% of patients with SCCHN are already locally advanced (60%) or metastatic (15%) when they first visit, and the median survival for patients with relapse and / or metastasis is only about 6 months. Patients who fail first-line treatment have a sharp decline in survival and usually die within 3 months.

Recipe : Recipe :

1. Oral prescription: 15g of Xinyi, 15g of Cork, 15g of habitat, 15g of cocklebur, 9g of araliae, 3g of asarum, 30g of light onion, 30g of Erythrina parasite, 1 pig nose.

2. For external use: 3 onion whites, 3 saponins, 0.15-0.2g musk, 6-9g fresh goose. Add 1 dose of water to make Qi decoction, 1 dose per day, and take 7-8 days after adding P. chinensis and P. sclerophylla, and then take 1 dose every other day, 5-7 doses, begonia fruit, peanut shell and jellyfish crab The shells are dried and ground, followed by the master, taking 1 dose every 3 days, and even 6-12 doses. Both sides use cotton dipped in medicinal juice to plug the ears. If the nose and ears bleed, the medicinal solution can be dripped in.

Addition and subtraction: Oral prescription plus 30g of yellow bark tree parasitism, 30g of bitter tree parasitic tree; nosebleeds and deafness and deafness plus 7 begonia fruit (outer skin), 20 peanut shells, 3-5 jellyfish crab shells; lump and Deafness plus 30g of Davidia involucrata parasites, 30g of goose does not eat grass.

Efficacy: A total of 4 cases were treated, 3 cases were significantly relieved, and 1 case was cured by taking 21 doses of this prescription, so far no recurrence.

Fang Yuan: Rural Wangshan Brigade, Wenchang County, Guangdong.

3. Take 0.3g of bezoar, 30g of prunella vulgaris, 1 dose per day, decoction of prunella vulgaris, and bezoar infusion (the longest surviving after treatment is 11 years).

Remedy:

30g of osmanthus root and 20g of gynostemma pentaphyllum.

30 grams of East China medicine tincture, first fry for two hours, then add wolfberry root, 30 grams each of yarrow, and 15 grams of seven leaves and one branch. Strain the decoction to take the juice.

Staging of head and neck cancer

Joint Committee on Cancer Staging

Primary tumor (T)

Oral cavity

Oral mucosa

Lower alveolar crest

Upper alveolar ridge

Molar molars (triangular area after molars)

Bottom of mouth

Hard

Two-thirds of the front end of the tongue

TX: tumor cannot be assessed

T0: No sign of primary tumor

T1: The maximum diameter of the primary tumor is 2 cm

T2: The maximum diameter of the primary tumor is 2 cm, but not more than 4 cm

T3: The maximum diameter of the primary tumor exceeds 4 cm

T4: The tumor begins to invade adjacent tissue structures (for example: through the bone dense into the tongue, maxillary sinus, deep muscle of the skin [in vitro test])

Oropharynx

Pharynx arch includes soft palate, uvula and anterior tonsil

Tonsil fossa and tonsil

Tongue base includes tongue epipharyngeal folds

The wall of the pharynx includes the lateral wall, posterior wall, and posterior tonsil column

TX: Primary tumor cannot be assessed

T0: No sign of primary tumor

Tis: malignant tumor in situ

T1: The maximum diameter of the primary tumor is 2 cm

T2: The maximum diameter of the primary tumor is 2 cm, but not more than 4 cm

T3: The maximum diameter of the primary tumor exceeds 4 cm

T4: The tumor begins to invade adjacent tissue structures (for example: through the bone dense into the tongue, maxillary sinus, deep muscle of the skin [in vitro test])

Glottis

Ventricular zone (false band)

Corrugated

Epiglottis (appearance of tongue and throat)

Epiglottis on hyoid bone

Epiglottis

Primary tumor (T)

TX: Primary tumor cannot be assessed

T0: No sign of primary tumor

Tis: malignant tumor in situ

T1: The tumor is confined to a secondary site on the glottis *, and the vocal cords have normal mobility.

T2: tumor invades glottis or mucosa at more than one secondary site on the glottis

T3: The tumor is confined to the larynx (with vocal cord fixation) & invades any of the following: posterior circular cartilage, tissues before the epiglottis

T4: The entire tumor spread beyond the throat, sweeping the soft tissues of the oropharynx, neck, or thyroid cartilage was damaged.

Glottis

Primary tumor (T)

T1: The tumor is confined to a normally moving vocal cord (possibly including before and after its junction)

T1a: tumor is confined to one vocal cord

T1b: tumor is confined to two vocal cords

T2: The tumor spreads to the upper and lower glottis, with reduced vocal cord mobility.

T3: The tumor is confined to the larynx, with vocal cord fixation

T4: The tumor spreads through the thyroid cartilage & spreads across the throat to other tissues (for example: soft tissues of the oropharynx, neck)

Lower glottis

Primary tumor (T)

T1: tumor is confined to lower glottis

T2: The tumor has spread to the vocal cords, the vocal cords move normally or decrease

T3: The tumor is confined to the larynx, with vocal cord fixation

T4: The tumor spreads through circular cartilage or thyroid cartilage & spreads across the throat to other tissues (for example: soft tissues of the oropharynx, neck)

Local lymph nodes (N)

NX: Local lymph nodes cannot be assessed

N0: no metastasis to local lymph nodes

N1: Unilateral metastasis of lymph nodes in the supraclavicular fossa, the maximum diameter is not more than 6 cm.

N2: bilateral metastasis to the lymph nodes in the supraclavicular fossa, the maximum diameter is not more than 6 cm.

N3: Lymph node metastasis

N3a: more than 6 cm in diameter

N3b: spread to the supraclavicular fossa

Transfer distance (M)

MX: Transfer distance cannot be assessed

M0: no transition distance

M1: With transfer distance

Illness grouping:

Stage I T1, N0, M0

Phase II T2, N0, M0

Stage III T3, N0, M0 T1, N1, M0 T2, N1, M0 T3, N1, M0

Stage IV T4, N0-1, M0 T1-4, N2-3, M0 any T, or any N, M1